title: Management of early-stage esophageal neoplasia (MESEN) consensus.
abstract: BACKGROUND
  Treatment of esophageal adenocarcinoma often involves surgical resection. Newer technologies in interventional endoscopy have led to a substantial paradigm shift in the management of early-stage neoplasia in Barrett's esophagus comprising high-grade dysplasia (HGD), intramucosal carcinoma, and, in some cases, submucosal carcinoma. However, there has been no consensus regarding the indications for esophageal preservation in these cases. In this work, consensus guidelines were established for the management of early-stage esophageal neoplasia considering clinically relevant aspects (age, comorbidities, and social environment) in each scenario.
  
  
  METHODS
  Seventeen experts were invited to participate based on their background and clinical expertise at high-volume centers. A questionnaire was created that included four clinical scenarios covering a wide range of situations within HGD and/or early esophageal neoplasia, particularly where controversies are likely to exist. Each of the clinical scenarios was open to discussion subdivided by patient age (20, 50, and 80 s). For each clinical scenario an expert was chosen to defend that position. Each defense triggered a subsequent discussion during a consensus meeting. Conclusions of that discussion together with an accompanying literature analysis allowed experts to confirm or change their original choices and served as the basis for the recommendations stated in this article.
  
  
  RESULTS
  There was 100 % consensus supporting esophageal preservation in patients with HGD, independent of patient age or Barrett's length. In patients with T1a adenocarcinoma, consensus for preservation was not reached (65 %) for young and middle-aged individuals but was supported for elderly patients (100 %). For T1b adenocarcinoma, consensus was reached for surgical resection (90 %), leaving organ preservation for patients with very low risk of nodal invasion or poor surgical candidates.
  
  
  CONCLUSIONS
  Advances in endoscopic imaging and therapy allow for organ preservation in most settings of early-stage neoplasia of the esophagus, provided that the patient understands the implications of this decision.
authors.affiliation: Department of Surgery, University of Favaloro, Av. Belgrano 1746, C1093AAS, Buenos Aires, Argentina, anieponi@ffavaloro.org.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Nieponice
authors.forename: Adolfo E
authors.initials: AE
authors.lastname: Badaloni
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Hoppo
authors.forename: Carlos
authors.initials: C
authors.lastname: Pellegrini
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: Kevin
authors.initials: K
authors.lastname: Reavis
authors.forename: Lee
authors.initials: L
authors.lastname: Swanstrom
authors.forename: Virender K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Fabio
authors.initials: F
authors.lastname: Nachman
authors.forename: Franco F
authors.initials: FF
authors.lastname: Ciotola
authors.forename: Luis E
authors.initials: LE
authors.lastname: Caro
authors.forename: Cecilio
authors.initials: C
authors.lastname: Cerisoli
authors.forename: Demetrio
authors.initials: D
authors.lastname: Cavadas
authors.forename: Luis Durand
authors.initials: LD
authors.lastname: Figueroa
authors.forename: Daniel
authors.initials: D
authors.lastname: Pirchi
authors.forename: Michael
authors.initials: M
authors.lastname: Gibson
authors.forename: Santiago
authors.initials: S
authors.lastname: Elizalde
authors.forename: Henry
authors.initials: H
authors.lastname: Cohen
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000465:Algorithms; D032921:Consensus; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D006801:Humans; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic